Tendon and Ligament injuries Flashcards
define the term tendinopathy
any form of injury to a tendon
give some causes of acute tendon rupture
overuse
eccentric activity
rapid acceleration or deceleration
give characterisitcs of the classical presentation of a tendinopathy
insidious onset
a specific site of pain
pain when person first starts to mobalise that eases after a period of warm up
pain following activity
give some examples of intrinsic causative factors for tendinopathy
gait heavy heal strike motor patterning age BMI previous injury
give some examples of extrinsic causative factors for tendinopathy
footwear
types of exercise mainly plyometrics
medications
sudden increases in volume or intensity of training
outline the three stages of the contimuum model for tendinopathy development
1) diffuse increased cellularity and ground substance
2) focal areas of collagen disorganization and neurovasular ingrowth
3) discrete islands of degenerative tendinopathy
describe what is seen in reactive tendinopathy
a non-inflammatory respinse seen to acute overload
increased proteoglycans which lead to water being drawn in via osmosis
therefore there is an increase in ground substance
fluid pressure or hypersensitive tenocyte = pain
how does rest help the tendon to recover in reactive tendinopathy
allows level of proteoglycans to decrease back to normal levels
describe what is seen in dysrepair tendinopathy
matrix becomes disorganised and collagen becomes seperated
tendon is thickened due to collogen becoming separated and ground substance forming
upregulation of VEGF to cause neo-vascularisation
glutamate and substance P also released which could be the cause of pain
describe what is seen in degenerative tendinopathy
significant collagen matrix disorganisation
‘holes’ within the tendon
increase in type 3 collagen
apoptosis of tenocytes
what areas do rehab programmes for tendinopathy focus on
pain reduction
increasing range of motion
address contractile deficit caused by lack of use
address and reinforce movement patterns to prevent recurrence
what is meant by stress shielding
a period of unloading of the tendon to protect it and allow some repair to take place
explain how isometrics are used in the first stage of recovery from achilles tendinopathy and what are the benefits of doing these exercises
stand on toes of the effective leg for 30-60 seconds
4 sets up to 5x per day
addresses contractile deficit
reduces pain and cortical inhibition
what is the second stage of rehab from achilles tendinopathy
progressive concentric and eccentric loading
these are slow, controlled movements through the range of motion to address contractile deficit
what is the third stage or rehab from achilles tendinopathy
heavy loading through the range of movement
when can a person who is recovering from tendinits move on to energy storage loading training
when there is minimal pain
or when limb strength is equivalent to the uninjured limb
describe what is meant by visoelasticity in relation to ligaments
will strain when under tension and then return to their original shape when tension is removed
under what conditions would a ligament not return to its original shape
excessive strain
under strain for a long period
strained very quickly
what characterisitc of the microstructure of a ligament allow it to stretch
the collagen fibres aren’t perfectly parallel
describe the grading system for ligamentous injuries
1 = sprained or stretched ligament but it is still compatent and able to stablise the joint
2= partial tear, still able to provide some stability and healing is possible
3 = complete tear so unable to stablise the joint
explain the non-surgical management options of ligament injuries
1) muscle strengthening to compensate
2) improve proprioception to increase how quickly the surrounding muscles will react
what is the general treatment outline for reactive tendinopath and early tendon dysrepair
load reduction to allow the tendon to react
what is the general treatment for tendon dyrepair and degenerative tendinopathy
physical activity which stimulates cell activity and protein production
